Differentiated thyroid carcinoma is a rare malignancy in children. It represents 0.4% to 3.0% of all childhood malignancies, with greater than 70% of cases presenting between the ages of 11 to 17 years and is exceptionally rare in children under 5 years of age. The most common type of differentiated thyroid carcinoma in children is papillary thyroid carcinoma, most of which are believed to be related to radiation exposure and only approximately 5% of cases have a family history of papillary thyroid cancer. In this report, we present a papillary thyroid carcinoma in a 3-year-old American boy with a family history of thyroid cancer and no known history of radiation exposure. A literature review with discussion on the management and treatment of pediatric papillary thyroid carcinoma follows.
A 21-year-old Caucasian man with a history of type 1 diabetes mellitus was admitted with complaints of persistent vomiting and abdominal pain for 2 days. Laboratory work revealed diabetic ketoacidosis, presumably secondary to non compliance. The patient was treated with intravenous fluids and insulin. The anion gap was normalized. However, he was not able to tolerate a liquid diet. Clinical examination revealed a slightly distended abdomen and positive bowel sounds. X-ray of the abdomen (Picture 1), followed by a CT scan of the abdomen (Picture 2) demonstrated radiolucencies and gas bubbles along the greater curvature, respectively (arrows), consistent with gastric emphysema. He was then continued on supportive management and nasogastric suction which led to gradual improvement in his condition.The other differential diagnosis for this condition is emphysematous gastritis. Gastric emphysema is benign compared to emphysematous gastritis which is generally associated with a much more ominous clinical course, requiring aggressive management with antibiotics and surgery in most cases (1).
Venous thromboembolism is a rarely described complication of diabetic ketoacidosis (DKA). We describe a 21-year-old male patient with poorly controlled type 1 diabetes mellitus who was admitted with DKA, presumably secondary to noncompliance, whose clinical picture was complicated by generalized thrombosis involving multiple venous locations including renal vein, pulmonary vasculature, external iliac and common iliac veins. The patient had no family history of any coagulation disorders and a hypercoagulabilty work-up remained negative. The patient was subsequently anticoagulated with heparin and discharged home on warfarin. To the best of our knowledge, this is the first reported case of multiple venous thromboses occurring as a complication of DKA with no other risk factors. We also reiterate that although rare, venous thrombosis should always be considered as a potential complication of DKA.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.